Bipolar disorder in children and adolescents –
What does it look like?
Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chippetta L, et al
The Bottom Line:
- Bipolar (BP) Disorder can be diagnosed in young children and teenagers.
- The way BP disorder begins to show itself is different in young people compared to adults.
- There is a good chance that the type of BP Disorder diagnosed in a child or adolescent will change over time.
- Some children and adolescents have a condition called BP-NOS (bipolar disorder not otherwise specified) that has only recently been described and is different from BP-1 or BP-2.
- BP-NOS is sometimes confused with ADHD or other conditions.
- Getting the correct diagnosis is important for treatment success.
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What problem is being addressed?
Bipolar (BP) Spectrum Disorder (sometimes called Manic-Depressive Illness) is a serious psychiatric illness that affects a person’s mood, energy levels, and ability to function.
Little has been known about how Bipolar Spectrum Disorder shows itself in children and teenagers. Many conditions are now called “spectrum disorders” because the symptoms and experiences of the people who have them can vary so much. Knowing the “natural history” of a disease or condition helps in diagnosing it correctly and providing the best treatment for it. Often, different conditions can look alike at their outset but begin to follow different courses as time passes.
This study looked at 263 children and adolescents with a diagnosis of BP Spectrum Disorder in an attempt to gain new understanding about how the illness progresses over time.
About Bipolar (BP) Spectrum Disorder
The symptoms of BP Disorder reflect a problem with mood regulation, but the way they are expressed in individuals can differ widely. In BP-1, there is usually only mania, that is, elation and/or irritability. In BP-2 there is a change between hypomania (a low level of mania) and depression. BP-NOS (not otherwise specified) is a condition whose symptoms differ from BP-1 and BP-2 in that there is elated mood with rapid alteration between mania and depression, recurrent hypomanic episodes without episodes of depression between them, delusions (e.g., a strong belief about something that is obviously false and that no argument will alter), or psychotic symptoms such as hearing voices or seeing things that aren’t there.
In Bipolar Disorder there can be shifts in the symptoms before they stabilize. Using a term like Bipolar Spectrum Disorder ensures that similar symptoms need not be categorized into one of several diagnoses, but can be seen as part of a single entity that features mood shifts and instability as the criterion on which the diagnosis is made and the individual is treated.
What is the real scientific evidence?
The study followed 263 children and adolescents, aged 7 to 17 years, 11 months, for an average of two years. All had been previously diagnosed with BP Spectrum Disorder.
Most of the participants had a diagnosis of BP-I or BP-NOS at the beginning of the study. Those with BP-I had more days of psychosis, particularly auditory hallucinations, e.g. hearing voices. Their illness also presented at an earlier age, and they had higher rates of Attention Deficit Hyperactivity Disorder (ADHD) diagnosis than children and teens with BP-II.
Those identified as having BP-NOS took longer to recover than those in the other groups. In both the BP-II and PB-NOS groups, 20% of the participants changed diagnosis to BP-I. The children and adolescents with BP-1 had worse symptoms and more frequent shifts of mood than those in the other groups. The participants with the worst outcomes were younger when their condition first started, came from poorer, less educated families, and had psychotic symptoms. This is the first study to show that the diagnosis of BP-NOS was likely to change, most commonly to BP-I.
Conclusions
BP-NOS is often missed because its symptoms don’t meet the requirements for the diagnosis of either BP-1 or BP-2 and it can be confused with other conditions like ADHD or a childhood psychotic disorder.
Practitioners and parents need to be aware that BP-NOS is a legitimate diagnosis. It is essential that a correct diagnosis be made so that effective treatment can be given.
The preceding is a summary of:
Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chippetta L, et al. Clinical Course of Children and Adolescents with Bipolar Spectrum Disorders. Archives of General Psychiatry 2006, 63: 175-183.
